obsolete constipation

Definition and Characteristics

Obsolete constipation, also referred to as chronic constipation in some contexts, refers to a bowel dysfunction characterized by infrequent or difficult evacuation of feces [2]. This condition is often associated with symptoms such as hard stools, excessive straining during bowel movements, and a sense of incomplete evacuation [14].

Symptoms

The symptoms of obsolete constipation can vary from person to person but typically include:

• Infrequent bowel movements (less than three times a week)
• Difficulty passing stool
• Hard or lumpy stools
• Excessive straining during bowel movements
• A feeling of incomplete evacuation after bowel movements

Causes and Contributing Factors

While the exact causes of obsolete constipation are not always clear, several factors can contribute to its development. These include:

• Lack of dietary fiber and fluids
• Sedentary lifestyle or lack of physical activity
• Certain medical conditions (e.g., hypothyroidism, diabetes)
• Medications that slow down bowel movements

Prevalence and Recognition

Obsolete constipation is a relatively common condition, affecting millions of people worldwide. However, it often remains unrecognized until the patient experiences significant discomfort or distress [11].

Symptoms of Constipation

Constipation is characterized by difficulty or discomfort having a bowel movement, hard, compacted stools that are difficult or painful to pass, straining during bowel movements, fewer bowel movements than usual, stomachache or bloating, and a feeling of incomplete emptying after a bowel movement [1][2][3].

Common Symptoms

• Difficulty or discomfort having a bowel movement
• Hard, compacted stools that are difficult or painful to pass
• Straining during bowel movements
• Fewer bowel movements than usual
• Stomachache or bloating
• A feeling of incomplete emptying after a bowel movement [4][5]

Chronic Constipation

Chronic constipation is having two or more of these symptoms for three months or longer. It can also feel like you have not fully emptied your bowels, and may be accompanied by a sense of rectal blockage or the need to use a finger to pass stool [6][7].

Impact on Quality of Life

Constipation can cause symptoms that become problematic and affect your quality of life. However, it can often be resolved with lifestyle changes and over-the-counter remedies [8]. If constipation becomes a regular problem, leads to complications, or is accompanied by alarming symptoms, it needs to be discussed with a healthcare provider.

References

[1] Apr 22, 2024 — What are symptoms of constipation? · Difficulty or discomfort having a bowel movement · Having small, hard bowel movements (sometimes described as ...

[2] Sep 11, 2023 — Hard, compacted stools that are difficult or painful to pass · Straining during bowel movements · Fewer bowel movements than usual · Stomachache or ...

[3] by BE Lacy · 2012 · Cited by 77 — Patients are more likely to report that they are constipated if they have straining at stool (52%), have hard stools (44%), have the urge to pass stool but ...

[4] Bowel obstructions usually cause cramping, abdominal pain, vomiting and inability to pass bowel motions (faeces or poo) or gas. A bowel obstruction is an ...

[5] What symptoms are related to constipation? · having trouble doing a bowel movement · not having a bowel movement as often as usual · passing hard, lumpy stools ...

[6] by J Heidelbaugh · 2021 · Cited by 15 — Chronic constipation is a gastrointestinal disorder that is characterized by lumpy or hard stools, infrequent bowel movements, abdominal ...

[7] by C HSIEH · 2005 · Cited by 253 — Management of chronic constipation includes keeping a stool diary to record the nature of the bowel movements, counseling on bowel training, increasing fluid ...

[8] Jan 28, 2022 — Fewer than three bowel movements per week · Straining during bowel movements · General discomfort or pain in the lower abdomen area · Your rectum ...

Diagnostic Tests for Constipation

Constipation is a common gastrointestinal disorder that can be caused by various factors, including structural or functional problems in the colon. Diagnostic tests are essential to identify the underlying cause of constipation and develop an effective treatment plan.

Types of Diagnostic Tests

Several diagnostic tests can help diagnose constipation, including:

• Imaging tests: These tests use X-rays, CT scans, MRI, or other imaging modalities to visualize the colon and rectum. Imaging tests can show where stool is present in the colon and if the colon is blocked.
• Tests of stool movement: These tests track the movement of stool through the colon using a balloon expulsion test or other methods.
• Laboratory tests: Blood tests, radiography, endoscopy, and other laboratory tests can help identify secondary causes of constipation, such as hypothyroidism.

Specific Diagnostic Tests

Some specific diagnostic tests for constipation include:

• Balloon expulsion test: This test involves pushing a small water balloon from the rectum to see if there is a problem pushing out stool.
• Lower gastrointestinal (GI) series: This imaging test uses X-rays and barium to visualize the colon and rectum.
• Magnetic resonance imaging (MRI): MRI can be used to diagnose conditions that may be causing constipation, such as tumors or narrowing of the colon.

When Diagnostic Tests Are Necessary

Diagnostic tests are usually necessary when:

• Alarm signs are present, such as blood in the stool, abdominal pain, or weight loss.
• Secondary causes of constipation need to be ruled out, such as hypothyroidism or neurological conditions.
• Constipation is refractory, meaning it does not respond to initial treatment.

References

1. [3] Diagnostic tests (e.g., blood tests, radiography, endoscopy) are not routinely recommended in the initial evaluation of a patient with chronic constipation in the absence of alarm signs or ...
2. [5] In chronic constipation, laboratory tests have a high diagnostic yield in adults and are essential for ruling out secondary causes of chronic constipation.
3. [11] Aside from a complete blood count, no tests are necessary in the absence of alarm symptoms; age-appropriate colonic structural evaluations should be performed.

Note: The numbers in square brackets refer to the context numbers provided, which are used to cite the relevant information.

Treatment Options for Obsolete Constipation

Obsolete constipation, also known as chronic idiopathic constipation (CIC), can be a challenging condition to manage. While dietary and lifestyle changes are often the first line of treatment, medication may be necessary in some cases.

• Tegaserod: This medication was approved by the FDA in 2006 for the treatment of CIC. It works by accelerating both orocecal transit time and proximal colonic filling at 6 hours (ZH Hussain, 2015). However, its use has been limited due to concerns about cardiovascular risks.
• Plecanatide: This is a newly approved guanylyl cyclase C agonist for the treatment of both chronic constipation and IBS-C. It demonstrated efficacy in clinical trials (AE Bharucha, 2019).
• Polyethylene glycol-based solutions (Miralax): These are effective, easy to administer, noninvasive, and well-tolerated in children with constipation (S NURKO, 2014).

Other Treatment Options

In addition to these medications, other treatment options may be considered for obsolete constipation. These include:

• Fiber supplements: Fiber can help regulate bowel movements and prevent constipation. Supplements like bran, inulin, and psyllium are recommended (AE Bharucha, 2020).
• Osmotic laxatives: Polyethylene glycol (PEG) is an osmotic laxative that works by causing water to be retained in the stool (AE Bharucha, 2020).
• Peripherally acting m-opiate antagonists: These are effective and relatively safe treatment options for

Understanding the Differential Diagnosis of Constipation

Constipation is a common digestive complaint that can be caused by various factors, including functional and organic conditions. The differential diagnosis of constipation involves identifying the underlying cause of the condition to provide an accurate diagnosis and effective treatment.

Functional vs. Organic Causes

Functional constipation refers to constipation caused by behavioral, dietary, or lifestyle modifications, whereas organic constipation is caused by a physical disorder or disease. According to [4], a history and physical examination are usually sufficient to distinguish functional constipation from constipation caused by organic conditions.

Common Causes of Organic Constipation

Organic constipation can be caused by various factors, including:

• Colonic obstruction
• Hypothyroidism
• Hypo- or hypercalcaemia
• Drug-induced constipation

These conditions often present with specific red flag signs and symptoms, such as abdominal pain, weight loss, or changes in bowel habits [7].

Dyssynergic Defecation

Dyssynergic defecation is a common cause of organic constipation, affecting up to one half of patients with chronic constipation [8]. This acquired behavioral problem is due to the inability to properly coordinate the muscles involved in defecation.

Other Considerations

In addition to the conditions listed above, other factors can contribute to constipation, such as:

• Reduced caloric intake
• Changes in bowel habits
• Presence of anorectal disorders or diverticular disease

It is essential to consider these factors when evaluating a patient with constipation [10].

Conclusion

The differential diagnosis of constipation involves identifying the underlying cause of the condition. By understanding the functional and organic causes, as well as common conditions that can contribute to constipation, healthcare professionals can provide an accurate diagnosis and effective treatment.

References:

[4] S NURKO · 2014 · Cited by 133 — A history and physical examination are usually sufficient to distinguish functional constipation from constipation caused by organic conditions. [7] Dec 27, 2018 — We will now briefly discuss several of the more common causes of organic constipation and the red flag signs and symptoms they may present with. [8] by SSC Rao · 2016 · Cited by 264 — Dyssynergic defecation is common and affects up to one half of patients with chronic constipation. This acquired behavioral problem is due to the inability to ... [10] Constipation is a symptom rather than a disease and, despite its frequency, often remains unrecognized until the patient develops sequelae, such as anorectal disorders or diverticular disease.